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COVID-19 infection associated with lower live birth rates in fresh embryo transfer cyclesCOVID-19 May Lower IVF Success Rates, New Data Shows

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Key Takeaway
Consider that COVID-19 infection was associated with lower live birth rates in fresh embryo transfer cycles in this observational study.

This was a retrospective cohort study from a single center, conducted from January 2021 to January 2023. It included 1,025 fresh embryo transfer (fET) cycles, with 762 in the non-infected group and 263 in the COVID-19-infected group. The primary exposure was COVID-19 infection, with the non-infected group as the comparator.

The main finding was a lower live birth rate (LBR) in the COVID-19 infection group. The adjusted odds ratio (OR) was 0.655 (95% CI 0.483 to 0.887; P=0.006). Mid-to-late miscarriage rates were higher in the infected group (adjusted OR 7.929; 95% CI 2.651 to 23.714; P<0.001). Subgroup analyses showed a lower LBR for infection 28–84 days before oocyte retrieval with fever ≥38.5°C (OR 0.467; 95% CI 0.290 to 0.752; P=0.002) and for dual-partner infection (OR 0.591; 95% CI 0.421 to 0.830; P=0.002).

Safety and tolerability data were not reported. Key limitations include the retrospective design, single-center setting, and small sample size for the infected group, requiring multicenter validation. The study reports associations, not causation. Practice relevance is that COVID-19 infection was associated with lower live birth rates in fET cycles, but specific clinical actions should await further evidence.

The IVF Question

You are planning for a baby. You have scheduled your IVF procedure. Then, you or your partner gets sick with COVID-19. Should you cancel the cycle? Or should you go ahead?

This is a stressful decision many couples face. A new study offers important data to help answer this question.

In vitro fertilization (IVF) is a medical procedure where an egg is fertilized outside the body. A fresh embryo transfer (fET) happens soon after the eggs are retrieved. Timing is everything in this process.

COVID-19 is still circulating. It is a respiratory illness that can affect the whole body. Doctors needed to know if catching the virus affects the outcome of fertility treatments.

Currently, guidelines are mixed. Some doctors cancel cycles if a patient tests positive. Others proceed. This study looked at over 1,000 cycles to see what actually happens.

The Old Way vs. The New Way

Previously, doctors worried mostly about the health of the mother during pregnancy. They focused on how COVID-19 affected the lungs or heart.

But this study looks at the very beginning of pregnancy. It asks: Does the virus affect the embryo’s ability to implant and grow?

The new data suggests the answer is yes. It shows a clear link between infection and lower success rates. This changes how we might view a positive test during an IVF cycle.

Think of the uterus like a garden. For a seed to grow, the soil must be ready.

Infection with a virus like COVID-19 causes inflammation. Inflammation is the body’s way of fighting germs. But it can also make the environment hostile.

If the body is fighting a virus, it may not focus energy on the uterine lining. This can make it harder for the embryo to implant. A high fever can also raise the body’s core temperature. This might affect egg quality or the uterine environment, similar to how heat can damage delicate electronics.

Researchers looked at 1,025 fresh embryo transfer cycles from January 2021 to January 2023. They compared two groups of women.

One group had no COVID-19 infection (762 cycles). The other group had a confirmed infection (263 cycles). They tracked who got pregnant and who had a live birth.

The results showed some surprising differences.

First, the physical size of the babies was the same. Newborns in both groups had similar birth weights and heights. This is reassuring.

However, the live birth rate was lower in the COVID-19 group. After adjusting for other factors, infected patients had about a 35% lower chance of a live birth.

They also found a higher rate of mid-to-late miscarriage in the infected group.

The Timing Matters

The researchers dug deeper into the data. They found that when the infection happened was critical.

Infections that occurred 28 to 84 days before the egg retrieval were risky. If the patient had a fever of 101.3°F (38.5°C) or higher, the live birth rate dropped significantly.

Here’s the catch.

The study also looked at partners. When both partners were infected, the live birth rate dropped even further. This suggests the virus may affect sperm quality or the couple's overall health during the cycle.

While this is a single study, it adds to a growing body of evidence. It suggests that timing and fever play a big role in IVF success during an infection.

Researchers emphasize that this is not a reason to panic. It is a reason to plan. If you are undergoing IVF and get COVID-19, talk to your doctor immediately.

If you are currently doing IVF, this study suggests caution. If you or your partner have a fever before egg retrieval, the success rate may be lower.

This does not mean you should stop treatment without medical advice.

Talk to your fertility specialist. They may suggest delaying the cycle to let your body recover. Every case is unique.

This study was retrospective. This means researchers looked back at past data rather than testing a new treatment in real-time.

Also, the study only looked at fresh embryo transfers. It did not look at frozen embryo transfers, which might react differently to infection.

Finally, the study was done at a single center. More diverse studies are needed to confirm these results.

What happens next? Researchers want to do larger, multicenter studies. They need to confirm if delaying IVF after a COVID-19 infection improves outcomes.

For now, this study provides valuable evidence. It helps doctors and patients make informed decisions during a stressful time.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
Background and aimsIt is important to clarify the impact of COVID-19 on ART outcomes and to develop evidence-based guidelines for deciding whether to proceed with or cancel in vitro fertility procedures in infected patients. This study aims to clarify the specific impacts of COVID-19 infection on the live birth rates (LBR) and fetal outcomes in patients undergoing fresh embryo transfer (fET) cycles.MethodsThis retrospective study analyzed 1,025 fresh embryo transfer cycles from January 2021 to January 2023. We compared pregnancy and neonatal outcomes between the non-infected group (n=762) and the COVID-19-infected group (n=263). Additionally, we stratified the infected group into subgroups by two criteria: time of infection, with or without fever and partner infection status, and further compared pregnancy outcomes of these subgroups. Univariate and multivariate logistic regression analyses were performed to assess differences in pregnancy and neonatal outcomes between non-infected and COVID-19-infected individuals.ResultsThe newborn’s gender, birth height and birth weight were comparable between the infected and uninfected groups. However, the COVID-19 infection group exhibited a lower LBR with an adjusted odds ratio (OR) of 0.655 (95% confidence interval (CI: 0.483 to 0.887; P = 0.006) and a higher mid-to-late miscarriage rates with an adjusted OR of 7.929 (95% CI: 2.651 to 23.714; P < 0.001) compared with the non-infections group. Stratified analysis showed that infections occurring between 28 and 84 days prior to oocyte retrieval accompanied by fever of ≥ 38.5°C resulted in a lower LBR (OR: 0.467, 95% CI: 0.290 to 0.752; P = 0.002 < 0.025) after Bonferroni’s correction. Additionally, the dual-partner infection group demonstrated a significantly reduced LBR (OR: 0.591, 95% CI: 0.421-0.830; P = 0.002 < 0.025) compared to uninfected controls.ConclusionCOVID-19 infection was associated with a lower LBR in fET cycles, especially when: infection occurred 28–84 days before oocyte retrieval with fever ≥ 38.5°C, or dual-partner were infected. Subsequent multicenter studies enrolling a significantly larger cohort of infected women or couples are essential to validate this finding.
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